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Vail Valley Medical Center

A Small Raft in Big Water Guide: Using Top-Down Leadership and Model Experience to Optimize in a Quarter of the Time

Vail Valley Medical Center has been a Cerner client for more than a decade.  And during that time, it heavily customized its Cerner solutions.  All that customization made installing and launching some projects double the standard Cerner timeline.

So when leaders at the Colorado-based regional healthcare facility wanted to implement a new physician documentation solution, they learned it could be a year-long project. Then, they discovered the Model Experience. 

“Cerner told us, with our level of customization, it would take about 12 months,” said Ryan Thousand. “We did it in three.”

And, the Manager of Clinical Applications added, “it was twice as easy as expected.”

Thousand, an outdoor enthusiast noted, “we faced this river – and we had to navigate it fast.”

Julie Jackson, a registered nurse and VVMC’s Clinical Project Lead, said the staff learned of Model Experience just as they reached a tipping point.  By their own admission, VVMC leaders struggled to keep up with PowerNote customization requests within a legacy system.

The single hospital health system began considering other electronic health vendors.

“We decided it was no longer financially sustainable to customize to everyone’s whim,” Jackson said.  “Historically, we would implement solutions and add two to three layers of customization.”

That tipping point coincided with the arrival of a new CIO/CMIO, Darrell Messersmith. 

“As much as possible, we have to use vendor-provided solutions to support standard workflows for all providers,” Messersmith said, “not spend more resources customizing things.”

The CIO/CMIO continued, “we needed the straight-out-of-the-box Cerner solutions that also provide the best technology tools available in the industry.”

“The Model Experience,” he emphasized, “helped us provide a framework and structure for implementation decisions rather than react to a wide variety of customization requests.”

The Model Experience is Cerner’s collection of recommendations for an optimal health care information system for clients. It includes guidelines on content, workflows, capabilities, configuration, technical specifications and key performance indicators.  It also suggests how organizations approach adopting those recommendations. 

This implementation and physician optimization project was VVMC’s foray into the Model Experience.

The health system focused on moving a few dozen doctors to Dynamic Documentation in November 2015. The first wave was small: five specialties and 40 physicians in both the acute and ambulatory spaces.  

“But,” said Ryan Thousand, “the degree of change made it incredibly complex.  Some physicians dictated into phones, some used hyper-customized PowerNotes, and some still used paper.” 

Thousand and the team took a different approach to this implementation.  “Instead of spending time to preserve those workflows, we took the road of implementing a new experience for our users.”

“We gave them a totally new look and feel using standardized tools,” Thousand said. 

The numbers speak for themselves.

    Orders time per patient dropped almost a minute. In October 2015, it was 2:09. In January 2016, it dropped to 1:12 – 30 seconds below the national health system leader’s average time. VVMC spent an average of nine minutes in the EHR per patient in January 2016 – a 40% drop from its 15:08 time in October 2015. Electronic documentation authored by physicians jumped above the national average – from roughly 47 percent to 66 percent in January. In March 2016, it climbed to 68 percent. The national average is 65 percent.

“After the implementation,” Messersmith said, “several physicians came up to me and said ‘we should’ve done this a long-time ago.’”

Thousand echoed the sentiment. "Physicians say the benefits of standardization far outweigh the customization,” he said. “They are actually using the EMR to research in a way that allows them to create documentation as a byproduct of that navigation.”

The team credits the adoption success to several factors: supportive leadership, constant communication, a culture change - but emphasized the Model Experience guidelines.

“For regional community hospitals trying to solve big problems with complex solutions, it sometimes feels like navigating a Class Five Rapids,” said Thousand. “But with the right river guide, the right paddles, and the right raft– it can be done.”

“We appreciate Cerner’s efforts,” added Messersmith, “and the ability to bring solutions in the form of the Model Experience - as opposed to just selling us technical tools to build our own solutions.”

He continued, “we are now doing things in three to four months that I was initially told was impossible.”

“Cerner has matured,” said Jackson, the clinical project lead. “Its associates have become the true subject matter experts with these Playbooks and the Model Experience. We needed that to be successful.”

“The end of this feels like coming the river,” said Thousand. “It only lasted a short time, but it was worth the effort spent.”

But this is also just the beginning. “Our optimization will never be over,” he continued. “Optimization is no longer a project, it is a process; organizations that stop optimizing fall behind.”

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Client outcomes were achieved in respective settings and are not representative of benefits realized by all clients due to many variables, including solution scope, client capabilities and business and implementation models.